| NPI | 1992785638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI RM039160) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI RM039160) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2016-12-12 |